长期照护医养结合的老年多器官功能不全综合征患者死亡危险因素分析

Risk factor for death in elderly patients with multiple organ dysfunction syndrome receiving long-term care

目的探讨长期照护医养结合的老年多器官功能不全综合征(MODSE)患者临床特点及死亡危险因素。方法回顾性分析2012年1月至2018年7月在长江大学附属江汉油田总医院老年医学科以医养结合形式住院的MODSE患者107例,根据发病后第28天转归分为存活组34例,死亡组73例。比较2组患者一般临床资料、急性生理与慢性健康状况评估Ⅱ(APACHEⅡ)评分、肺部感染评分、脑功能Glasgow昏迷量表评分、吞咽功能评分等。采用SPSS 17.0统计软件进行分析。根据数据类型,组间比较采用t检验或χ~2检验。将单因素分析中有统计学意义的指标纳入多因素Cox回归模型分析影响MODSE患者死亡的因素。结果 (1)2组患者一般资料比较,年龄、器官功能不全数、收缩压、舒张压、平均动脉压、二氧化碳分压、氧分压、氧合指数、血红蛋白、白蛋白、空腹血糖、血尿素氮差异有统计学意义(P<0.01)。(2)2组患者基础疾病≥4种、慢性阻塞性肺疾病(COPD)、慢性心力衰竭、脑血管病、糖尿病、痴呆与认知功能障碍、肺部感染评估量表≥6分、Glasgow昏迷量表评分、APACHEⅡ≥25分、吞咽困难分级量表≤4分以及肺、心、肾、脑、胃肠功能不全占比比较,差异有统计学意义(P<0.05)。(3)多因素Cox回归分析显示,年龄、器官功能不全数、APACHEⅡ评分、Glasgow昏迷量表评分、肺部感染评分及COPD、慢性心力衰竭、脑血管病、血清白蛋白是引起长期照护医养结合的MODSE患者死亡的独立危险因素。结论患多种基础疾病的医养结合的MODSE高龄患者,合并有COPD、慢性心力衰竭、脑血管病、肺部感染、低血清白蛋白更易导致死亡,要加强早期监测和预防。

Objective To investigate the clinical characteristics and risk factors for death in the elderly patients with multiple organ dysfunction syndrome(MODSE) receiving long-term care and a combination of medical treatment and nursing care. Methods A retrospective study was conducted of 107 MODSE patients admitted to the Department of Geriatrics in Jianghan Oilfield General Hospital from January 2012 to July 2018, who were given a combination of medical treatment and nursing care. According to the outcome at day 28 after onset, the MODSE patients were divided into the survival group(n=34) and death group(n=73). The two groups were compared in the general clinical data, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, pulmonary infection score, Glasgow coma scale score of brain function and swallowing function score. SPSS statistics 17.0 was used for analysis, and t test or Chi-square test was applied for comparison between 2 guoups. Multivariate Cox regression was performed with statistically significant indices in the univariate analysis for independent risk factors affecting the mortality of MODSE patients. Results(1) Comparison of the general data found significant differences between the two groups in age, organ dysfunction number, systolic blood pressure, diastolic blood pressure, mean arterial pressure, partial pressure of carbon dioxide, oxygen partial pressure, oxygenation index, hemoglobin, albumin, fasting blood glucose, and blood urea nitrogen(P<0.01).(2) Comparison in the proportion of chronic diseases found significant differences between two groups in underlying diseases ≥4, chronic obstructive pulmonary disease(COPD), chronic heart failure, cerebrovascular disease, diabetes mellitus, dementia and cognitive impairment, pulmonary infection assessment scale≥6, Glasgow coma scale score, APACHE Ⅱ≥25, dysphagia grading scale ≤4, and lung, heart, kidney, brain and gastrointestinal insufficiency(P<0.05).(3) Multivariate Cox regression showed that age, organ dysfunction number, APACHE Ⅱ score, Glasgowcoma scale score, pulmonary infection score and COPD, chronic heart failure, cerebrovascular disease and serum albumin were independent risk factors for death in the MODSE patients with long-term care. Conclusion Death is more likely in the elderly MODSE patients with a variety of underlying diseases accompanied with COPD, chronic heart failure, cerebrovascular disease, pulmonary infection, and low serum albumin, and early monitoring and prevention should be strengthened.